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KF Damji, R Ritch, A Merkur, W Hodge, AG P Konstas, NG Ziakas, S Giannikakis, JM Liebmann, G Mintsioulis; Prospective Multi-Center Trial of Long-Term Intraocular Pressure (IOP) Change Following Phacoemulsification Cataract Extraction (PCE) in Patients With and Without Pseudoexfoliation (PEX) . Invest. Ophthalmol. Vis. Sci. 2002;43(13):296.
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Purpose: To determine the long-term IOP response to PCE in patients with PEX and appropriate controls. Method: Prospective multi-center cohort study with the following inclusion criteria: age greater than 50, open angle, and a cataract requiring PCE. Patients with glaucoma were enrolled if preoperative IOP was controlled on 2 or less meds, C/D ratio was less than or equal to 0.85, and no visual field defect was present within 10 degrees of fixation.Two groups were enrolled - those with PEX and those without. The main outcome was IOP change at 1 and 2 yrs vs. preoperative IOP. Data was also collected on early postoperative IOP spikes (greater than or equal to 6 mm Hg rise from baseline). Univariate and multivariate analyses were performed. Results: 183 eyes were enrolled, 71 with PEX and 112 without PEX. There were 29 eyes with glaucoma in both groups. Baseline variable such as age and gender were similar but the PEX group did have significantly higher baseline IOP compared to non PEX (17.60 +/- 3.23 vs. 16.08 +/- 3.18 mm Hg, p=0.002) and heavier meshwork pigmentation. The percentage of patients with a post-op IOP spike was similar and relatively high in both PEX and non PEX groups (31% vs. 26%, day 1; 16% vs. 27%, wk 3) but this had settled by 6 wks (0% vs. 5.3%). Conclusion: IOP decreases significantly following PCE in eyes with PEX vs. controls at 6 months, but this trend loses significance by 1yr and is almost lost by 2yrs. Given that almost one third of PEX and control eyes had an early post-op IOP spike, this needs to be considered when deciding whether to perform PCE alone, or whether to perform sequential or combined glaucoma and cataract surgery in patients with PEX. Acknowledgments: Lindberg Society for assistance with the protocol. Sophia Chaudry, Hamidah Meghani, Anuj Bhargava and Amy Bovell assisted in data collection and tabulation. View OriginalDownload SlideView OriginalDownload Slide
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